| NPI | 1417474859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE LE ANNE BEIDMAN Owner 208-746-7661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LMSW36870) |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: ID LMSW36870) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-07-21 |